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Recurrent Pancreatitis Triples Risk for Chronic Disease
TOPLINE:
The overall progression to chronic pancreatitis among adults was three times higher following recurrent episodes of acute pancreatitis than occurring after just the first acute pancreatitis episode.
METHODOLOGY:
- The progression of acute pancreatitis is time-dependent, with the recurrence and progression rates to recurrent acute pancreatitis and chronic pancreatitis varying based on the follow-up duration and may be affected by the cause and severity of the first acute episode.
- To better understand the progression of acute pancreatitis to recurrent acute pancreatitis and chronic pancreatitis, researchers conducted a systematic review and meta-analysis of 119 studies, all of which were used for qualitative and quantitative synthesis and 29 of which also were used for calculating incidence rates.
- The primary outcomes were the incidence rates of recurrent acute and chronic pancreatitis following the initial episode of acute pancreatitis and the incidence rate of chronic pancreatitis after recurrent episodes of acute pancreatitis.
- The secondary outcomes were the cumulative incidences and proportions of recurrent acute and chronic pancreatitis following the initial acute pancreatitis episode and the proportion of chronic pancreatitis occurring after recurrent acute pancreatitis episodes.
TAKEAWAY:
- The incidence rate of recurrent acute pancreatitis after the first acute episode was 5.26 per 100 person-years in adults and 4.64 per 100 person-years in children, a difference that did not reach statistical significance.
- The progression rate to chronic pancreatitis in adults was threefold higher after recurrent acute pancreatitis episodes than after the first acute pancreatitis episode (4.31 vs 1.38 per 100 person-years).
- Hypertriglyceridemia-induced acute pancreatitis had the highest recurrence rates, followed by alcohol-induced, idiopathic, and biliary pancreatitis.
- The overall progression rate into chronic pancreatitis was 8% after the first acute pancreatitis episode and 24% after recurrent episodes of acute pancreatitis. Progression to chronic pancreatitis among adults was highest among those with alcohol-induced disease, followed by idiopathic and biliary pancreatitis.
- A moderately severe first episode of acute pancreatitis was associated with the highest recurrence rate, followed by mild and severe first episodes.
IN PRACTICE:
The authors emphasized the need to develop new interventions to address the factors associated with acute pancreatitis and its progression and to better utilize existing approaches, such as brief and repeated psychological interventions and alcohol and smoking cessation programs. Deeper investigation into the underlying causes of the disease’s etiology is warranted to reduce recurrence and progression rates, they noted.
SOURCE:
The study, led by Endre-Botond Gagyi, MD, of the Center for Translational Medicine, Semmelweis University, Budapest, Hungary, was published online in Therapeutic Advances in Gastroenterology.
LIMITATIONS:
Most of the studies included in the analysis were retrospective, and there was high heterogeneity between them. The researchers could only analyze the presence of recurrent acute pancreatitis but could not explore the number of episodes or their impact on progression due to the lack of reported data.
DISCLOSURES:
The study was funded by the New National Excellence Program of the Ministry for Innovation and Technology from the National Research, Development and Innovation Fund. The authors declared no conflict of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
The overall progression to chronic pancreatitis among adults was three times higher following recurrent episodes of acute pancreatitis than occurring after just the first acute pancreatitis episode.
METHODOLOGY:
- The progression of acute pancreatitis is time-dependent, with the recurrence and progression rates to recurrent acute pancreatitis and chronic pancreatitis varying based on the follow-up duration and may be affected by the cause and severity of the first acute episode.
- To better understand the progression of acute pancreatitis to recurrent acute pancreatitis and chronic pancreatitis, researchers conducted a systematic review and meta-analysis of 119 studies, all of which were used for qualitative and quantitative synthesis and 29 of which also were used for calculating incidence rates.
- The primary outcomes were the incidence rates of recurrent acute and chronic pancreatitis following the initial episode of acute pancreatitis and the incidence rate of chronic pancreatitis after recurrent episodes of acute pancreatitis.
- The secondary outcomes were the cumulative incidences and proportions of recurrent acute and chronic pancreatitis following the initial acute pancreatitis episode and the proportion of chronic pancreatitis occurring after recurrent acute pancreatitis episodes.
TAKEAWAY:
- The incidence rate of recurrent acute pancreatitis after the first acute episode was 5.26 per 100 person-years in adults and 4.64 per 100 person-years in children, a difference that did not reach statistical significance.
- The progression rate to chronic pancreatitis in adults was threefold higher after recurrent acute pancreatitis episodes than after the first acute pancreatitis episode (4.31 vs 1.38 per 100 person-years).
- Hypertriglyceridemia-induced acute pancreatitis had the highest recurrence rates, followed by alcohol-induced, idiopathic, and biliary pancreatitis.
- The overall progression rate into chronic pancreatitis was 8% after the first acute pancreatitis episode and 24% after recurrent episodes of acute pancreatitis. Progression to chronic pancreatitis among adults was highest among those with alcohol-induced disease, followed by idiopathic and biliary pancreatitis.
- A moderately severe first episode of acute pancreatitis was associated with the highest recurrence rate, followed by mild and severe first episodes.
IN PRACTICE:
The authors emphasized the need to develop new interventions to address the factors associated with acute pancreatitis and its progression and to better utilize existing approaches, such as brief and repeated psychological interventions and alcohol and smoking cessation programs. Deeper investigation into the underlying causes of the disease’s etiology is warranted to reduce recurrence and progression rates, they noted.
SOURCE:
The study, led by Endre-Botond Gagyi, MD, of the Center for Translational Medicine, Semmelweis University, Budapest, Hungary, was published online in Therapeutic Advances in Gastroenterology.
LIMITATIONS:
Most of the studies included in the analysis were retrospective, and there was high heterogeneity between them. The researchers could only analyze the presence of recurrent acute pancreatitis but could not explore the number of episodes or their impact on progression due to the lack of reported data.
DISCLOSURES:
The study was funded by the New National Excellence Program of the Ministry for Innovation and Technology from the National Research, Development and Innovation Fund. The authors declared no conflict of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
The overall progression to chronic pancreatitis among adults was three times higher following recurrent episodes of acute pancreatitis than occurring after just the first acute pancreatitis episode.
METHODOLOGY:
- The progression of acute pancreatitis is time-dependent, with the recurrence and progression rates to recurrent acute pancreatitis and chronic pancreatitis varying based on the follow-up duration and may be affected by the cause and severity of the first acute episode.
- To better understand the progression of acute pancreatitis to recurrent acute pancreatitis and chronic pancreatitis, researchers conducted a systematic review and meta-analysis of 119 studies, all of which were used for qualitative and quantitative synthesis and 29 of which also were used for calculating incidence rates.
- The primary outcomes were the incidence rates of recurrent acute and chronic pancreatitis following the initial episode of acute pancreatitis and the incidence rate of chronic pancreatitis after recurrent episodes of acute pancreatitis.
- The secondary outcomes were the cumulative incidences and proportions of recurrent acute and chronic pancreatitis following the initial acute pancreatitis episode and the proportion of chronic pancreatitis occurring after recurrent acute pancreatitis episodes.
TAKEAWAY:
- The incidence rate of recurrent acute pancreatitis after the first acute episode was 5.26 per 100 person-years in adults and 4.64 per 100 person-years in children, a difference that did not reach statistical significance.
- The progression rate to chronic pancreatitis in adults was threefold higher after recurrent acute pancreatitis episodes than after the first acute pancreatitis episode (4.31 vs 1.38 per 100 person-years).
- Hypertriglyceridemia-induced acute pancreatitis had the highest recurrence rates, followed by alcohol-induced, idiopathic, and biliary pancreatitis.
- The overall progression rate into chronic pancreatitis was 8% after the first acute pancreatitis episode and 24% after recurrent episodes of acute pancreatitis. Progression to chronic pancreatitis among adults was highest among those with alcohol-induced disease, followed by idiopathic and biliary pancreatitis.
- A moderately severe first episode of acute pancreatitis was associated with the highest recurrence rate, followed by mild and severe first episodes.
IN PRACTICE:
The authors emphasized the need to develop new interventions to address the factors associated with acute pancreatitis and its progression and to better utilize existing approaches, such as brief and repeated psychological interventions and alcohol and smoking cessation programs. Deeper investigation into the underlying causes of the disease’s etiology is warranted to reduce recurrence and progression rates, they noted.
SOURCE:
The study, led by Endre-Botond Gagyi, MD, of the Center for Translational Medicine, Semmelweis University, Budapest, Hungary, was published online in Therapeutic Advances in Gastroenterology.
LIMITATIONS:
Most of the studies included in the analysis were retrospective, and there was high heterogeneity between them. The researchers could only analyze the presence of recurrent acute pancreatitis but could not explore the number of episodes or their impact on progression due to the lack of reported data.
DISCLOSURES:
The study was funded by the New National Excellence Program of the Ministry for Innovation and Technology from the National Research, Development and Innovation Fund. The authors declared no conflict of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
Acid Blockers Appear Superior to PPIs in Erosive Esophagitis
TOPLINE:
, a meta-analysis suggests.
METHODOLOGY:
- Researchers conducted a database search up to May 31, 2023, for randomized controlled trials of potassium-competitive acid blockers and PPIs for the treatment of erosive esophagitis. They included 34 trials in a systematic review and a network meta-analysis comparing the efficacy of the two medication classes in this patient population.
- The trials included 25,054 patients with erosive esophagitis, and the treatments involved were standard or double doses of potassium-competitive acid blockers (tegoprazan, vonoprazan, keverprazan, and fexuprazan), PPIs (esomeprazole, ilaprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole), or placebo.
- The researchers compared the healing rates at 4 and 8 weeks.
TAKEAWAY:
- The main analysis found that both potassium-competitive acid blockers and PPIs showed better healing rates at 4 and 8 weeks than placebo. This finding held up in a subgroup analysis of patients with and without severe erosive esophagitis at both time points.
- For most treatments, the pooled healing rates at 8 weeks were significantly higher than those at 4 weeks.
- In the main analysis, ilaprazole 10 mg once daily had the best healing rate (surface under the cumulative ranking curve [SUCRA], 89.3) at 4 weeks, followed by vonoprazan 40 mg once daily (SUCRA, 86.7). At 8 weeks, keverprazan 20 mg once daily ranked best (SUCRA, 84.7), followed by ilaprazole 10 mg once daily (SUCRA, 82.0).
- The subgroup analysis found that healing rates were higher with most potassium-competitive acid blockers than with PPIs, particularly for patients with severe erosive esophagitis. Keverprazan 20 mg daily was found to have the highest healing rate at 8 weeks for both severe and non-severe erosive esophagitis, and vonoprazan 40 mg daily had a relatively higher healing rate at 4 weeks.
IN PRACTICE:
The finding that most potassium-competitive acid blockers showed a higher healing rate than PPIs, particularly for patients with severe erosive esophagitis, “may help inform future directions of treatment,” the authors wrote. But high-quality randomized controlled trials are required to confirm potassium-competitive acid blockers’ healing effect in patients with erosive esophagitis, they added.
SOURCE:
The study, led by Yin Liu of the Henan Cancer Hospital (Affiliated Cancer Hospital of Zhengzhou University), Zhengzhou, and Zhifeng Gao of the Department of Gastroenterology, The First People’s Hospital of Xuzhou, Xuzhou, China, was published online in Therapeutic Advances in Gastroenterology.
LIMITATIONS:
The limitations of the study included heterogeneity and bias across included studies, a lack of head-to-head trials for all included treatments, and insufficient reporting on outcomes based on the severity of erosive esophagitis.
DISCLOSURES:
The authors received no financial support for the study. There were no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
, a meta-analysis suggests.
METHODOLOGY:
- Researchers conducted a database search up to May 31, 2023, for randomized controlled trials of potassium-competitive acid blockers and PPIs for the treatment of erosive esophagitis. They included 34 trials in a systematic review and a network meta-analysis comparing the efficacy of the two medication classes in this patient population.
- The trials included 25,054 patients with erosive esophagitis, and the treatments involved were standard or double doses of potassium-competitive acid blockers (tegoprazan, vonoprazan, keverprazan, and fexuprazan), PPIs (esomeprazole, ilaprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole), or placebo.
- The researchers compared the healing rates at 4 and 8 weeks.
TAKEAWAY:
- The main analysis found that both potassium-competitive acid blockers and PPIs showed better healing rates at 4 and 8 weeks than placebo. This finding held up in a subgroup analysis of patients with and without severe erosive esophagitis at both time points.
- For most treatments, the pooled healing rates at 8 weeks were significantly higher than those at 4 weeks.
- In the main analysis, ilaprazole 10 mg once daily had the best healing rate (surface under the cumulative ranking curve [SUCRA], 89.3) at 4 weeks, followed by vonoprazan 40 mg once daily (SUCRA, 86.7). At 8 weeks, keverprazan 20 mg once daily ranked best (SUCRA, 84.7), followed by ilaprazole 10 mg once daily (SUCRA, 82.0).
- The subgroup analysis found that healing rates were higher with most potassium-competitive acid blockers than with PPIs, particularly for patients with severe erosive esophagitis. Keverprazan 20 mg daily was found to have the highest healing rate at 8 weeks for both severe and non-severe erosive esophagitis, and vonoprazan 40 mg daily had a relatively higher healing rate at 4 weeks.
IN PRACTICE:
The finding that most potassium-competitive acid blockers showed a higher healing rate than PPIs, particularly for patients with severe erosive esophagitis, “may help inform future directions of treatment,” the authors wrote. But high-quality randomized controlled trials are required to confirm potassium-competitive acid blockers’ healing effect in patients with erosive esophagitis, they added.
SOURCE:
The study, led by Yin Liu of the Henan Cancer Hospital (Affiliated Cancer Hospital of Zhengzhou University), Zhengzhou, and Zhifeng Gao of the Department of Gastroenterology, The First People’s Hospital of Xuzhou, Xuzhou, China, was published online in Therapeutic Advances in Gastroenterology.
LIMITATIONS:
The limitations of the study included heterogeneity and bias across included studies, a lack of head-to-head trials for all included treatments, and insufficient reporting on outcomes based on the severity of erosive esophagitis.
DISCLOSURES:
The authors received no financial support for the study. There were no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
, a meta-analysis suggests.
METHODOLOGY:
- Researchers conducted a database search up to May 31, 2023, for randomized controlled trials of potassium-competitive acid blockers and PPIs for the treatment of erosive esophagitis. They included 34 trials in a systematic review and a network meta-analysis comparing the efficacy of the two medication classes in this patient population.
- The trials included 25,054 patients with erosive esophagitis, and the treatments involved were standard or double doses of potassium-competitive acid blockers (tegoprazan, vonoprazan, keverprazan, and fexuprazan), PPIs (esomeprazole, ilaprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole), or placebo.
- The researchers compared the healing rates at 4 and 8 weeks.
TAKEAWAY:
- The main analysis found that both potassium-competitive acid blockers and PPIs showed better healing rates at 4 and 8 weeks than placebo. This finding held up in a subgroup analysis of patients with and without severe erosive esophagitis at both time points.
- For most treatments, the pooled healing rates at 8 weeks were significantly higher than those at 4 weeks.
- In the main analysis, ilaprazole 10 mg once daily had the best healing rate (surface under the cumulative ranking curve [SUCRA], 89.3) at 4 weeks, followed by vonoprazan 40 mg once daily (SUCRA, 86.7). At 8 weeks, keverprazan 20 mg once daily ranked best (SUCRA, 84.7), followed by ilaprazole 10 mg once daily (SUCRA, 82.0).
- The subgroup analysis found that healing rates were higher with most potassium-competitive acid blockers than with PPIs, particularly for patients with severe erosive esophagitis. Keverprazan 20 mg daily was found to have the highest healing rate at 8 weeks for both severe and non-severe erosive esophagitis, and vonoprazan 40 mg daily had a relatively higher healing rate at 4 weeks.
IN PRACTICE:
The finding that most potassium-competitive acid blockers showed a higher healing rate than PPIs, particularly for patients with severe erosive esophagitis, “may help inform future directions of treatment,” the authors wrote. But high-quality randomized controlled trials are required to confirm potassium-competitive acid blockers’ healing effect in patients with erosive esophagitis, they added.
SOURCE:
The study, led by Yin Liu of the Henan Cancer Hospital (Affiliated Cancer Hospital of Zhengzhou University), Zhengzhou, and Zhifeng Gao of the Department of Gastroenterology, The First People’s Hospital of Xuzhou, Xuzhou, China, was published online in Therapeutic Advances in Gastroenterology.
LIMITATIONS:
The limitations of the study included heterogeneity and bias across included studies, a lack of head-to-head trials for all included treatments, and insufficient reporting on outcomes based on the severity of erosive esophagitis.
DISCLOSURES:
The authors received no financial support for the study. There were no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
How Common Are Life-Threatening Infections In Infants with Pustules, Vesicles?
TOPLINE:
, according to the findings from a retrospective study.
METHODOLOGY:
- Researchers reviewed the electronic medical records of infants aged ≤ 60 days who received a pediatric dermatology consultation at six US academic institutions between September 2013 and August 2019.
- Among 879 consults, 183 afebrile infants were identified as having presented with pustules, vesicles, and/or bullae.
- Infectious disease workups included blood cultures, urine cultures, lumbar punctures, and HSV testing using viral skin culture, direct immunofluorescence assay, and/or polymerase chain reaction.
- Patients were categorized by gestational age as preterm (< 37 weeks), full-term (37-42 weeks), and post-term (≥ 42 weeks).
- Overall, 67.8% of infants had pustules, 31.1% had vesicles, and 10.4% had bullae.
TAKEAWAY:
- None of the cases showed positive cerebrospinal fluid or pathogenic blood cultures. In 122 of the cases (66.6%), a noninfectious cause was diagnosed, and an infectious cause was diagnosed in 71 cases (38.8%; some patients had more than one diagnosis).
- Of the 127 newborns evaluated for HSV infection, nine (7.1%) tested positive, of whom seven (5.5%) had disease affecting the skin, eye, and mouth and were full- term infants, and two (1.6%) had disseminated HSV and were preterm infants.
- Angioinvasive fungal infection was diagnosed in five infants (2.7%), all of whom were preterm infants (< 28 weeks gestational age).
- The risk for life-threatening disease was higher in preterm infants born before 32 weeks of gestational age (P < .01) compared with those born after 32 weeks.
IN PRACTICE:
“Full-term, well-appearing, afebrile infants ≤ 60 days of age presenting with pustules or vesicles may not require full SBI [serious bacterial infection] work-up, although larger studies are needed,” the authors concluded. Testing for HSV, they added, “is recommended in all infants with vesicles, grouped pustules, or pustules accompanied by punched out or grouped erosions,” and preterm infants “should be assessed for disseminated fungal infection and HSV in the setting of fluid-filled skin lesions.”
SOURCE:
The study was led by Sonora Yun, BA, Columbia University, New York City, and was published online in Pediatrics.
LIMITATIONS:
The data were limited by the sample size and very low incidence of serious infections. Infants probably had atypical or severe presentations that warranted pediatric dermatology consultation, which may have led to overrepresentation of infectious disease rates. The study inclusion was restricted to those who received a dermatology consult; therefore, the findings may not be generalizable to outpatient primary care.
DISCLOSURES:
This study did not receive any external funding. The authors declared that they had no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
, according to the findings from a retrospective study.
METHODOLOGY:
- Researchers reviewed the electronic medical records of infants aged ≤ 60 days who received a pediatric dermatology consultation at six US academic institutions between September 2013 and August 2019.
- Among 879 consults, 183 afebrile infants were identified as having presented with pustules, vesicles, and/or bullae.
- Infectious disease workups included blood cultures, urine cultures, lumbar punctures, and HSV testing using viral skin culture, direct immunofluorescence assay, and/or polymerase chain reaction.
- Patients were categorized by gestational age as preterm (< 37 weeks), full-term (37-42 weeks), and post-term (≥ 42 weeks).
- Overall, 67.8% of infants had pustules, 31.1% had vesicles, and 10.4% had bullae.
TAKEAWAY:
- None of the cases showed positive cerebrospinal fluid or pathogenic blood cultures. In 122 of the cases (66.6%), a noninfectious cause was diagnosed, and an infectious cause was diagnosed in 71 cases (38.8%; some patients had more than one diagnosis).
- Of the 127 newborns evaluated for HSV infection, nine (7.1%) tested positive, of whom seven (5.5%) had disease affecting the skin, eye, and mouth and were full- term infants, and two (1.6%) had disseminated HSV and were preterm infants.
- Angioinvasive fungal infection was diagnosed in five infants (2.7%), all of whom were preterm infants (< 28 weeks gestational age).
- The risk for life-threatening disease was higher in preterm infants born before 32 weeks of gestational age (P < .01) compared with those born after 32 weeks.
IN PRACTICE:
“Full-term, well-appearing, afebrile infants ≤ 60 days of age presenting with pustules or vesicles may not require full SBI [serious bacterial infection] work-up, although larger studies are needed,” the authors concluded. Testing for HSV, they added, “is recommended in all infants with vesicles, grouped pustules, or pustules accompanied by punched out or grouped erosions,” and preterm infants “should be assessed for disseminated fungal infection and HSV in the setting of fluid-filled skin lesions.”
SOURCE:
The study was led by Sonora Yun, BA, Columbia University, New York City, and was published online in Pediatrics.
LIMITATIONS:
The data were limited by the sample size and very low incidence of serious infections. Infants probably had atypical or severe presentations that warranted pediatric dermatology consultation, which may have led to overrepresentation of infectious disease rates. The study inclusion was restricted to those who received a dermatology consult; therefore, the findings may not be generalizable to outpatient primary care.
DISCLOSURES:
This study did not receive any external funding. The authors declared that they had no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
, according to the findings from a retrospective study.
METHODOLOGY:
- Researchers reviewed the electronic medical records of infants aged ≤ 60 days who received a pediatric dermatology consultation at six US academic institutions between September 2013 and August 2019.
- Among 879 consults, 183 afebrile infants were identified as having presented with pustules, vesicles, and/or bullae.
- Infectious disease workups included blood cultures, urine cultures, lumbar punctures, and HSV testing using viral skin culture, direct immunofluorescence assay, and/or polymerase chain reaction.
- Patients were categorized by gestational age as preterm (< 37 weeks), full-term (37-42 weeks), and post-term (≥ 42 weeks).
- Overall, 67.8% of infants had pustules, 31.1% had vesicles, and 10.4% had bullae.
TAKEAWAY:
- None of the cases showed positive cerebrospinal fluid or pathogenic blood cultures. In 122 of the cases (66.6%), a noninfectious cause was diagnosed, and an infectious cause was diagnosed in 71 cases (38.8%; some patients had more than one diagnosis).
- Of the 127 newborns evaluated for HSV infection, nine (7.1%) tested positive, of whom seven (5.5%) had disease affecting the skin, eye, and mouth and were full- term infants, and two (1.6%) had disseminated HSV and were preterm infants.
- Angioinvasive fungal infection was diagnosed in five infants (2.7%), all of whom were preterm infants (< 28 weeks gestational age).
- The risk for life-threatening disease was higher in preterm infants born before 32 weeks of gestational age (P < .01) compared with those born after 32 weeks.
IN PRACTICE:
“Full-term, well-appearing, afebrile infants ≤ 60 days of age presenting with pustules or vesicles may not require full SBI [serious bacterial infection] work-up, although larger studies are needed,” the authors concluded. Testing for HSV, they added, “is recommended in all infants with vesicles, grouped pustules, or pustules accompanied by punched out or grouped erosions,” and preterm infants “should be assessed for disseminated fungal infection and HSV in the setting of fluid-filled skin lesions.”
SOURCE:
The study was led by Sonora Yun, BA, Columbia University, New York City, and was published online in Pediatrics.
LIMITATIONS:
The data were limited by the sample size and very low incidence of serious infections. Infants probably had atypical or severe presentations that warranted pediatric dermatology consultation, which may have led to overrepresentation of infectious disease rates. The study inclusion was restricted to those who received a dermatology consult; therefore, the findings may not be generalizable to outpatient primary care.
DISCLOSURES:
This study did not receive any external funding. The authors declared that they had no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Making Repeated Treatment Changes May Help Resolve Difficult-to-Treat RA
TOPLINE:
Nearly half of patients with difficult-to-treat rheumatoid arthritis (D2T RA) no longer met the criteria for that status at the end of a 5-year period by achieving disease remission or low disease activity with additional treatment modifications.
METHODOLOGY:
- This retrospective cohort study included 150 patients with D2T RA, as defined by the European Alliance of Associations for Rheumatology, in 2018 at Keio University Hospital, Tokyo.
- The researchers followed patients until 2023 and collected data on demographics, treatment changes, disease activity, and outcomes.
- D2T RA resolution was defined as achieving remission or low disease activity for ≥ 3 consecutive months.
TAKEAWAY:
- Overall, 45% of patients achieved resolution of D2T RA at a mean duration of 24.1 months.
- Treatment changes were more frequent in patients with resolved disease vs those with persistent D2T RA (83.6% vs 58.7%; P = .002).
- Patients with resolved D2T RA were more frequently treated with interleukin-6 receptor inhibitors in 2023 vs 2018 (35.8% vs 20.0%; P = .04) and less often treated with prednisolone (14.9% vs 38.7%; P < .001).
- Over 5 years, 5% of the patients died; increased glucocorticoid doses were linked to mortality (P = .002).
IN PRACTICE:
“Although a treatment strategy for difficult-to-treat RA has not yet been established, our study suggests that the optimal treatment choice for patients with difficult-to-treat RA is distinct, based on the causes,” wrote the authors.
SOURCE:
The study was led by Satoshi Takanashi, MD, PhD, from Keio University School of Medicine in Tokyo. It was published online in Rheumatology.
LIMITATIONS:
The study’s single-center design and relatively small sample size may limit the generalizability of the findings. Treatment changes were decided by attending doctors, which could introduce bias. The investigators were also unable to determine the impact of any comorbid fibromyalgia in the patients.
DISCLOSURES:
The study was supported by the JCR Grant for Promoting Research for Difficult-to-Treat Rheumatoid Arthritis, a KAKENHI grant from the Japan Society for the Promotion of Science, and Keio University Medical Science Fund. Each of the study’s three authors reported financial relationships with various manufacturers of drugs for RA.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Nearly half of patients with difficult-to-treat rheumatoid arthritis (D2T RA) no longer met the criteria for that status at the end of a 5-year period by achieving disease remission or low disease activity with additional treatment modifications.
METHODOLOGY:
- This retrospective cohort study included 150 patients with D2T RA, as defined by the European Alliance of Associations for Rheumatology, in 2018 at Keio University Hospital, Tokyo.
- The researchers followed patients until 2023 and collected data on demographics, treatment changes, disease activity, and outcomes.
- D2T RA resolution was defined as achieving remission or low disease activity for ≥ 3 consecutive months.
TAKEAWAY:
- Overall, 45% of patients achieved resolution of D2T RA at a mean duration of 24.1 months.
- Treatment changes were more frequent in patients with resolved disease vs those with persistent D2T RA (83.6% vs 58.7%; P = .002).
- Patients with resolved D2T RA were more frequently treated with interleukin-6 receptor inhibitors in 2023 vs 2018 (35.8% vs 20.0%; P = .04) and less often treated with prednisolone (14.9% vs 38.7%; P < .001).
- Over 5 years, 5% of the patients died; increased glucocorticoid doses were linked to mortality (P = .002).
IN PRACTICE:
“Although a treatment strategy for difficult-to-treat RA has not yet been established, our study suggests that the optimal treatment choice for patients with difficult-to-treat RA is distinct, based on the causes,” wrote the authors.
SOURCE:
The study was led by Satoshi Takanashi, MD, PhD, from Keio University School of Medicine in Tokyo. It was published online in Rheumatology.
LIMITATIONS:
The study’s single-center design and relatively small sample size may limit the generalizability of the findings. Treatment changes were decided by attending doctors, which could introduce bias. The investigators were also unable to determine the impact of any comorbid fibromyalgia in the patients.
DISCLOSURES:
The study was supported by the JCR Grant for Promoting Research for Difficult-to-Treat Rheumatoid Arthritis, a KAKENHI grant from the Japan Society for the Promotion of Science, and Keio University Medical Science Fund. Each of the study’s three authors reported financial relationships with various manufacturers of drugs for RA.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Nearly half of patients with difficult-to-treat rheumatoid arthritis (D2T RA) no longer met the criteria for that status at the end of a 5-year period by achieving disease remission or low disease activity with additional treatment modifications.
METHODOLOGY:
- This retrospective cohort study included 150 patients with D2T RA, as defined by the European Alliance of Associations for Rheumatology, in 2018 at Keio University Hospital, Tokyo.
- The researchers followed patients until 2023 and collected data on demographics, treatment changes, disease activity, and outcomes.
- D2T RA resolution was defined as achieving remission or low disease activity for ≥ 3 consecutive months.
TAKEAWAY:
- Overall, 45% of patients achieved resolution of D2T RA at a mean duration of 24.1 months.
- Treatment changes were more frequent in patients with resolved disease vs those with persistent D2T RA (83.6% vs 58.7%; P = .002).
- Patients with resolved D2T RA were more frequently treated with interleukin-6 receptor inhibitors in 2023 vs 2018 (35.8% vs 20.0%; P = .04) and less often treated with prednisolone (14.9% vs 38.7%; P < .001).
- Over 5 years, 5% of the patients died; increased glucocorticoid doses were linked to mortality (P = .002).
IN PRACTICE:
“Although a treatment strategy for difficult-to-treat RA has not yet been established, our study suggests that the optimal treatment choice for patients with difficult-to-treat RA is distinct, based on the causes,” wrote the authors.
SOURCE:
The study was led by Satoshi Takanashi, MD, PhD, from Keio University School of Medicine in Tokyo. It was published online in Rheumatology.
LIMITATIONS:
The study’s single-center design and relatively small sample size may limit the generalizability of the findings. Treatment changes were decided by attending doctors, which could introduce bias. The investigators were also unable to determine the impact of any comorbid fibromyalgia in the patients.
DISCLOSURES:
The study was supported by the JCR Grant for Promoting Research for Difficult-to-Treat Rheumatoid Arthritis, a KAKENHI grant from the Japan Society for the Promotion of Science, and Keio University Medical Science Fund. Each of the study’s three authors reported financial relationships with various manufacturers of drugs for RA.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.